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Priniclpes Of Anesthesia > Nerve blocks (exam 4) > Flashcards

Nerve blocks (exam 4) Flashcards

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1
Q

Brachial plexus components

A

Roots
Trunks
Divisions
Cords
Branches

(Reach to Drink Cold Beverages)

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1
Q

Brachial plexus roots (and how many)

A

5 roots:
C5
C6
C7
C8
T1

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2
Q

Brachial plexus trunks (and how many)

A

3 trunks:
Superior
Middle
Inferior

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3
Q

Brachial pelxus divisions #

A

6

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4
Q

Brachial plexus cords (and how many)

A

3 Cords
Lateral
Posterior
Medial

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5
Q

Brachial plexus branches (and how many)

A

5 branches
Musculocutaneous n
Axillary n
Radial n
Median n
Ulnar n

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6
Q

Musculocutaneous n is innervated at

A

C5-7

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7
Q

Axillary n is innervated at

A

C5-6

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8
Q

Radial n is inervatted at

A

C5-T1

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9
Q

Median n is innervated at

A

C5-T1

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10
Q

Ulnar N is innervated

A

C8-T1

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11
Q

Brachial plexus flow

A
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12
Q

Medial nerve pre op neuro exam

A

Touch thumb and pinky

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13
Q

Ulnar nerve pre op nuero exam

A

spread hands/fingers
“OK” pinch thumb and index

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14
Q

Radial pre op neuro exam

A

“stop” flex hand up
thumbs up

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15
Q

Radial nerve pre op STRENGTH neuro exam

A

Push’eR
elbow extension against resistance (triceps contraction)

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16
Q

Musculocutaneous preop STRENGTH neuro exam

A

Pull’eM
elbox flexion against resistance (biceps contracation)

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17
Q

median n. preop STRENGTH neuro exam

A

Pinch Me: pinch patients index finger

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18
Q

Ulnar n preop STRENGTH neuro exam

A

Pinch U: pinch patients pinky finger (5th digit)

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19
Q

Pre block neuro exam for lower extremities

A
  1. ankle dorsifelxion (flex to head)
  2. Great toe dorsiflexion
  3. ankle plantar flexion (point ball of foot)
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20
Q

Interscalene block indications

A

Shoulder surgery (includes rotator cuff)
Upper arm surgery (proximal humerus)
Distal clavicle

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21
Q

Interscalene block roots

A

C5-C7

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22
Q

Inerscalene landmarks

A

It is lateral to the subclavian artery

Landmarks:
Sternocleidomastoid (inferior to)
Middle scalene muscle
Anterior scalene muscle

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23
Q

Block contraindications (7)

A
  1. patient refusal
  2. contralateral diaphragmatic paralysis
  3. injection
  4. LA allergy
  5. Severe resp disease
  6. COPD
  7. Anticoagulation
  8. Preexisting neurodeficits
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24
For goal of post operative pain management (i.e. in infusion), you should use
0.25% marcaine or ropiviacaine
25
For goal of surgical anesthesia, you should use
0.375-0.5% marcaine or ropivicaine (denser)
26
Phrenic nerve is innervated at
C3-C5
27
Supraclavicular nerve is innervated at
C3-C4
28
Supraclavicular indications
Upper arm Elbow Wirst Hand
29
Supraclavicular landmark
Lateral to subclavian artery Superior to first rib
30
Supraclavicular: what do you aim for and what is it
"corner pocket" Where 1st rib meets subclavian arter
31
Nerve stimulator use in blocks
to ensure you are not intranueronal, especially above shoulders
32
What will proglong a single shot block
concentration (density) of LA and adjuncts NOT volume (volume can affect spread)
33
axillary nerve block indications
Forearm, hand, wrist
34
Axillary block positioning
arm up at 90 degrees
35
Axillary block landmarks
-musculocutaneous nerve -axillary artery -nerves: median, ulnar, radial
36
Axillary block landmarks
-musculocutaneous nerve -axillary artery -nerves: median, ulnar, radial
37
Femoral block indications
-hip (fracture pain control and surgery) -Femur -Quad -Knee for surgery, often used in conjunction with sciatic block for full coverage
38
Femoral landmarks
"triangle" fascia lata -Femoral artery -Fascia lata -ilioposoas muscle
39
Femoral depth
3-5 cm
40
Fascia lata
Femoral nerve branches within
41
Adductor canal block indication
Knee surgery (anterior/medial aspects) Ankle ACL Medial portion of leg, foot, angle *must block with vastus medialis nerve to achieve full anterior knee analgesia
42
Adductor canal block blocks the
saphenous nerve
43
Adductor canal/saphenous triangle landmarks
Sartorius muscle anteriorly Vastus medialis laterally Adductor longus medially
44
adductor canal landmarks (beyond triangle)
Superficial femoral artery Femoral vein Saphenous nerve
45
adductor canal landmarks
46
adductor canal block position
frog leg (use blankets to prob leg up if necessary)
47
PENG block stands for
perricapsular nerve group block
48
PENG block indication
Fracture of femoral neck Hip arthroscopy/plasty Pain management
49
PENG is a ____ block
Sensory only (no motor)
50
What nerves does the PENG block cover
obturator Femoral accessory obturator (50%)
51
PENG block landmarks
Anterior superior illiac spine (ASIS) AIIS Pubis ligament inguinal ligament
52
PENG block reasons for failure
Failure to injuct under psoas muscle/tendon Poor local spread alone ilium (where nerves are located) Technique Failure to cabture lateral femoral cutaneou
53
Popliteal sciatic known complications
foot drop intraneural injection high risk *use nerve stimulater and hydrodissect
54
Popliteal Sciatic indications
Podiatry, below knee, calf, ankle -Post operative pain management -Surgeon preference -Primary anesthetic
55
Popliteal sciatic anatomy
Sciatic nerve slightly above the knee, sciatic branches into tibial and common peroneal
56
Popliteal sciatic landmarks
Popliteal artery Biceps femoris, semitendenous, semimembranous muscles Bifurcation of sciatic nerve into common tibial and common peroneal nerve
57
Popliteal sciatic position
-supine, operative leg elevated
58
Popliteal sciatic transducer type and placement
linear array placed in popliteal crease short axis image
59
Where do you block in popliteal sciatic
where tibial nerve and common peroneal nerve share a sheath but are not touching "kissing"
60
For popliteal sciatic block, there is a high risk for ____ so you should ____
nueral injection. No adjunts, 5 mL increments, use a nerve stimulator
61
a TAP (transversus abdominal planus) block is a
somatic block only
62
TAP block indication
-hernia repair -appendectomy open -laparoscopic abdominal
63
TAP block provides analgesia to
skin muscle parietal peritoneum
64
Subcostal/midaxillary TAP block landmarks
Rectus abdominus External oblique Internal oblique Transverse abdominis
65
Mid axillary aka
lateral approach
66
Mid exillary/lateral approach landmarks
mid axillary line superior and parallel to iliac crest EO IO TA
67
What type of spread do you want in TAP block?
lateral
68
Mid axillary TAPS approach
through external oblique and internal oblique block between internal oblique and transversus abdominus
69
Ilioinguinal-iliohypogastric / posterior TAP block indication
hernias
70

Priniclpes Of Anesthesia (19 decks)

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